strengthening social comptence in children and youth with autistic spectrum disorders

1
strengthening social comptence in children and
youth with autistic spectrum disorders

• luke moynahan, Børge Strømgren Mickey Keenan
• 2004

2
social competence

• persons demonstrate social competence when they
• initiate and sustain reciprocal interpersonal
  relationships with members of their intimate and
  effective social networks
• attain personal goals with high probability and
  contribute effectively to attaining collective
  goals
• satisfy culturally determined explicit rules and
  implicit norms for conduct in accordance with
  established fundamental human rights,
• result in positive evaluation by others.

3
markers

• social competence is a behavioural competence
  that cannot be fully understood independent of
  contextual demands
• it can not be defined solely with respect to the
  capacity or behavioural dexteritey of the
  individual
• from a teaching perspective it is useful to take
  account of both contextual and developmental
• social arenas
• family, school, community, work
• dyads, groups and larger systems
• age developmental transitions
• skill complexity
• subtlety of contextual stimuli

4
positive consequences

• research within developmental social psychology
  (Durkin, 1995)
• social and clinical psychology (Seligman,
  Barlow Durand, 1996)
• reveals that children who demonstrate high
  levels of social competence
• improved physical health, higher school
  achievement, larger social networks and higher
  degree of perceived social support, higher
  probability of employment

5
costs of non-competence

• children who demonstrate low social competence
  reveal increased vulnerability to
• poor physical health
• educational under achievement
• family dysfunction including high levels of
  family stress factors,
• social isolation and weak social networks,
• increased risk of conduct disorders, aggressive
  and anti-social behaviour
• increased risk of susbtance abuse
• underemployment and unemployment
• (Andrews Dodge Farrington Loeber Patterson
  Ogden Svedhem)

6
autism

• Autism is defined primarily in relation to the
  inability to initiate and maintain social
  relations and to pervasive failure to vary
  behaviour according to context
• autism is particularly devastating in its effects
  upon the family
• parental cohesion, sibling relations
• autism can have deleterious effects on family
  members participation in extrafamilial activities
  
• school, leisure, work, friendships, community
  engagement

7
autism sc

• autistic children will not acquire sufficient
  repertoires of academic, social or vocational
  skills by mere exposure to the contingencies of
  normal life.
• neither will they acquire reporoires comparable
  to their non-autistic peers through provision of
  standard education
• they require specialized systematic educational
  services as early as possible
• they may require flexible specialized
  habilitation services throughout their lives
• such services must not only target the individual
  with autism men must focus on the childs family
  and effective social network (Dunst, 1994
  Powers, 1990 Carr et al, 2000)

8
programmes for teaching social competence
9
young children-play

• a lack of varied spontaneous make believe play is
  a defining feature of autism. It si also one of
  the most reliable early signs ogf autism.
  (Boucher Wolfberg, 2003)
• cooperative play provides a rich source of tasks
  and challenges that can be used to strengthen
  social competence
• fair play, turn taking, delay of gratification,
  rule governed play, choice taking, decision
  making, cooperation in teams, leadership.

10
play norwegian studies

• teaching children with autism to initiate and
  sustain cooperative play (Jahr, Eldevik
  Eikeseth, 2000 Jahr Tryggestad, 2001?)
• the methods chosen were
• modelling and multiple exemplars
• observation with and without verbal description
• participation in cooperative play
• initiation of play with novel partners without
  instruction or prompts

11
markers

• children had participated in Løvaas Early
  Intensive Behavioural Intervention
• could engage in simple play by themselves.
• could describe simple play responses
• multiple exemplars
• differing forms of play
• increasing complexity
• description of the behaviour of the models
• in contrast to Meichenbaum (1977) modelling av
  self-instructions

12
results
13
junior school senior school
14
schoolbased programmes

• Prepare Curriculum (Goldstein, 1988, 1999)
  consists of 10 programmes
• skillstreaming (ineterpersonal skills)
• situational perception training
• problem solving training
• stress management training
• anger control training
• cooperation training
• understanding and using groups
• empathy training
• moral reasoning training
• recruiting pro-social support

15
PEACE CURRICULUM

• Cuuriculum developed by Sara Salmon and
  colleagues as extended ART at peace4allkids,
  Center for Safe Schools and Communities
• P Parental empowerment
• E Empathy training
• A Aggression management
• C Character education
• E Essential social skills

16
Aggression Replacement Training

• developed with multi- problem, delinquent youth
  in youth correctional facilities in north eastern
  USA by Arnold Goldstein, Barry Glick John Gibbs
  (1988 1998)
• based on social learning analysis of aggression
  (Bandura, 1973), stress innoculation training
  (Meicenbaum, Novaco Feindler) and Moral
  Development paradigm (Kohlberg, 1968).
• Comprises three components
• skillstreaming
• anger control training
• moral reasoning training

17
skillstreaming
18
skillstreaming

• basic training method (group)
• 2 trainers demonstrate the chosen skill twice
• discussion of the relevance of the skill to
  students own lives, similar experiences etc are
  briefly discussed
• role play step by step replay of the modelled
  skill, trainers provide and rapidly fade specific
  prompts in order for the students to attain
  fluent use of the skill
• feedback response specific feedback to the main
  actor is provided by the co-actor and the group.
  Video is used to highlight important details
  
• homework and transfer training tasks are planned

19
transfer training"

• laminated skill cards highlight the major steps
  and rules for use, trainers may use fotoflows
  (self-modelling) as well as booster training in
  natural settings
• overlearning the group design ensures several
  repititions of the skill (multiple exemplar
  training) homework tasks also ensure further
  trials
• identical elements roleplays are made as
  lifelike as possible shift of training to
  actual locations

20
transfer training"

• stimulus variation invite other trainers,
  students to session, train in several locations
  at different times, creative use of homework
• use of reinforcement contingencies students are
  trained in self-reinforcement , contrived
  external reinforcement contingencies may be
  planned with parents other teachers etc, group
  contingencies and toekn economies may be
  established to ensure vicarious reinforcement

21
skillstreaming

• adjustments to skillstreaming
• selection of skills based upon functional
  assessment by child, parents and teachers
• simultaneous and delayed imitation training
• microtraining fluency training of microskill
  elements with rapid, response specific feedback
• use of video in training of self-evaluation of
  performance (reflexive feedback)
• commentator (simultaneous descriptor) and
  director (functional instruction) training

22
Anger control training

• 1. INTRODUCTION, ABCs of anger
• 2. TRIGGERS external triggers and internal
  triggers
• 3. ANGER CUES (signals) muscle tightening,
  clenched fists, pounding heart
• ANGER REDUCERS deep breathing, backwards
  counting, pleasant imagery
• 4. POSITIVE REMINDERS self-instructional
  statements

23
STEPS WEEK BY WEEK

• 5. SELF-EVALUATION self-rewarding statements
• 6. THINKING AHEAD, figure out the C (consequence)
  in the ABC-model
• 7. ANGRY BEHAVIOR CYCLE what do YOU do to make
  others angry
• 8. REHEARSAL OF FULL SEQUENCE steps 1-7 social
  skill
• 9. REHEARSAL OF FULL SEQUENCE hassle log review
• 10. OVERALL REVIEW full sequence

24
anger control training

• adjustments
• fluency training in identification of anger
  signals, interne and externe triggers
• extension of anger reducers mindfulness
  procedures
• regaining of self control
• transformation of response functions
• turning point and bubble talk techniques
• magic remote control
• response specific feedback group and reflexive
  variations with use of video

25
moral reasoning training

• dilemma discussion methods

26
dilemma discussion method 1

• the goal is to create conflict (cognitive
  dissonance) perturb students immature or
  dogmatic moral stance
• group composition and dynamics are vital
  trainers must ensure that the group comprises
  both stage 1 2 reasoners
• rules must ensure active participation, respect
  for each others opinions and the right to
  disagree
• discussion starts with the trainer who presents
  the dilemma, copies are given to each student
• trainer asks for opinions from each member and
  leads discussion.

27
dilemma discussion method 1

• trainers encourage differences of opinion
• when level 1 reasoners are confronted by level 2
  reasoners whom they like and respect the level 1
  reasoners experience a dilemma that is
  uncomfortable (dissonance)
• trainers adjourn discussion until the next
  meeting
• level 1 reasoners often seek out level 2
  reasoners and seek further clarification (why did
  you say that? why do you mean that? between
  session change

28
dilemma discussion method 2

• the goal is to help the group arrive at a more
  mature moral reasoning level
• 1 a written dilemma is provided to each member
  and is read out loud by the trainer or group
  members
• 2 trainers lead a summary of the dilemma (with
  use of flipover)
• 3 trainers then elicit opinions, suggestions
  and solutions form each member
• 4 trainers then conduct a polling of support
  for each suggestion etc

29
dilemma discussion method 2

• 5 group is divided into two smaller groups
• 6 each trainer helps her/his smaller group
  refine their arguments
• 7 a spokesperson is chosen to present the
  opinions and arguments of the smalle group
• 8 the larger group reconvenes arguments from
  both smaller groups are written up on the
  flipover
• 9 the group debates the newer arguments
• 10- debate continues until consensus is obtained
  or that members agree that they are satisfied
  with own presentation

30
moral reasoning training

• adjustments
• presentation of dilemmas in role play format
  where trainees assume roles in continuation of
  role play
• use of triple dance and four step method to
  encourage flexibility of social perspective and
  empathy
• coorespondence training verbal behaviour as
  guide for motoric performance

31
results individual and family applications
32

33
(No Transcript)
34
Bergsmarksetra Movie 1
35
Bergsmarksetra Movie 1
36
(No Transcript)
37
(No Transcript)
38
(No Transcript)
39
(No Transcript)
40
classroom and whole school applications
41
projects

• Larvik Municipality and Røyken Rural Community
• establishment of community wide ART PEACE
• initiated by single referrals of ASD pupils
• joint experimental cooperation
• all participants are researchers
• analyste are temprorary members of the change
  network
• social competence training that works for ASD
  will also work and be valued by normal peers

42
three phases

• interventive assessment and collective analysis
• data that means something
• dat that functions as MOm for headmasters,
  teachers , parents and pupils
• strengthening competence and connecting
• proactive and preventative
• connecting to new actors, activities and arenas
• consolidation

43

• Larvik - over 500 pupils have participated in ART
• 180 teachers, child welfare workers, nurses and
  youth psychiatric professionals have been trained
  as ART practitioners to ICART standards
• family ART- Berg Junior School pilot project
  begins may 2004

44

• Røyken all schools in the community will
  partcipate
• public council commitment by local politicians to
  reduce and prevent anti social and aggressive
  behaviour in schools
• parent and family mobilization
• joint experimental cooperation
• all interventions are data based
• all participants are committed to collection and
  analysis of data celeration charts, quality of
  school life surveys, frequency registration of
  positive interactions in classroom, corridors,
  schoolyard to and from school

45
summary
46
skillstreaming-

• selection of skills according to functional value
• test battery, existing competence behavioural
  observation, increased reinforcement, reduced
  punishment, aversive stimulation
• fluency training methods, microtrainig
• behaviour specific feedback
• Arne Scheie (commentator) Steven Spielberg
  (director)

47
anger control training

• expansion of anger reducers
• regaining self-control
• mindfulness skills
• transformation of response functions
• fluency procedures
• anger signals, bubble talk
• turning point
• graded exposure (GEARS)

48
moral reasoning training

• presentation of dilemmas in role play format
• use of triple dance, 4 step,
• correspondence training
• say - do